MSRA Practice Exam Questions and Answers
Latest Updated| 100% Correct
1. A 62-year-old man presents with sudden severe headache “worst ever”, vomiting and
photophobia. BP 195/112 mmHg. CT head normal. A. Start oral nimodipine B. Discharge
with paracetamol C. Perform lumbar puncture D. Give IV labetalol immediately
2. 36 weeks pregnant woman, BP 162/104 mmHg, headache + visual blurring, urine PCR 92
mg/mmol. A. Immediate emergency caesarean B. IV magnesium sulphate + plan
delivery within 24–48 hours C. Oral labetalol only D. Nifedipine MR + outpatient review
3. 48-year-old heavy drinker presents confused, ataxic, bilateral horizontal nystagmus. A. IV
50% glucose first B. High potency IV thiamine (Pabrinex) immediately C.
Chlordiazepoxide 30 mg QDS D. Haloperidol 5 mg IM
4. 32-year-old woman, dysuria + frequency + suprapubic pain, no fever, no loin tenderness,
nitrites ++, leucocytes ++. A. Nitrofurantoin MR 100 mg BD for 3 days B. Trimethoprim
200 mg BD for 3 days C. Cefalexin 500 mg BD for 7 days D. Ciprofloxacin 500 mg BD for 3
days
5. 29-year-old woman, severe right iliac fossa pain, vomiting, positive pregnancy test, BP
88/54 mmHg, HR 118. A. Threatened miscarriage B. Appendicitis C. Ruptured ectopic
pregnancy D. Ovarian torsion
6. 6-week-old infant, projectile non-bilious vomiting after feeds, palpable olive in RUQ. A.
GORD B. Infantile hypertrophic pyloric stenosis C. Volvulus D. Sepsis
7. 58-year-old man, sudden right arm & leg weakness + expressive dysphasia, onset 90
minutes ago, CT no bleed. A. Aspirin 300 mg stat B. IV alteplase (if no contraindications)
C. Clopidogrel 300 mg stat D. LMWH therapeutic dose
, 8. 71-year-old woman RA on methotrexate, 4 months progressive dry cough + SOB, CXR
bilateral interstitial changes. A. Rheumatoid ILD B. Methotrexate pneumonitis C.
Pulmonary embolism D. PCP pneumonia
9. 19-year-old man, sudden severe left testicular pain 3 hours, nausea, high-riding tender
testis, absent cremasteric reflex. A. Urgent scrotal ultrasound B. Immediate surgical
exploration C. IV antibiotics + analgesia D. Conservative management 6 hours
10. 65-year-old smoker, 5 weeks cough + haemoptysis + 7 kg weight loss, CXR right hilar
mass. A. Sputum cytology ×3 B. Staging CT chest/abdomen/pelvis C. Bronchoscopy first
D. PET-CT immediately
11. 34-year-old woman, severe headache, neck stiffness, photophobia, fever 39.2°C, drowsy
but obeys commands. A. CT head then LP B. IV ceftriaxone 2 g + IV aciclovir
immediately C. Dexamethasone 10 mg IV first D. Oral amoxicillin
12. 69-year-old COPD patient, 4 days productive cough, increasing SOB. ABG on 28% O₂: pH
7.27, PaCO₂ 10.1 kPa, PaO₂ 6.2 kPa. A. Nebulisers only B. Prednisolone + antibiotics C.
Non-invasive ventilation (BiPAP) D. Immediate intubation
13. 54-year-old man AF on warfarin, large melaena, BP 89/52 mmHg, INR 8.4. A. Vitamin K
10 mg IV B. Fresh frozen plasma C. Prothrombin complex concentrate (4-factor PCC) D.
Tranexamic acid only
14. 78-year-old woman, 3 weeks progressive confusion, urinary incontinence, wide-based
gait. CT → ventriculomegaly, no atrophy. A. Alzheimer’s disease B. Vascular dementia C.
Normal pressure hydrocephalus D. Lewy body dementia
15. 41-year-old woman, menorrhagia 9 months, Hb 79 g/L, ferritin 5 μg/L, normal pelvic
ultrasound. A. Tranexamic acid during periods B. Levonorgestrel IUS (Mirena) C.
Tranexamic acid + mefenamic acid D. Endometrial ablation first
Latest Updated| 100% Correct
1. A 62-year-old man presents with sudden severe headache “worst ever”, vomiting and
photophobia. BP 195/112 mmHg. CT head normal. A. Start oral nimodipine B. Discharge
with paracetamol C. Perform lumbar puncture D. Give IV labetalol immediately
2. 36 weeks pregnant woman, BP 162/104 mmHg, headache + visual blurring, urine PCR 92
mg/mmol. A. Immediate emergency caesarean B. IV magnesium sulphate + plan
delivery within 24–48 hours C. Oral labetalol only D. Nifedipine MR + outpatient review
3. 48-year-old heavy drinker presents confused, ataxic, bilateral horizontal nystagmus. A. IV
50% glucose first B. High potency IV thiamine (Pabrinex) immediately C.
Chlordiazepoxide 30 mg QDS D. Haloperidol 5 mg IM
4. 32-year-old woman, dysuria + frequency + suprapubic pain, no fever, no loin tenderness,
nitrites ++, leucocytes ++. A. Nitrofurantoin MR 100 mg BD for 3 days B. Trimethoprim
200 mg BD for 3 days C. Cefalexin 500 mg BD for 7 days D. Ciprofloxacin 500 mg BD for 3
days
5. 29-year-old woman, severe right iliac fossa pain, vomiting, positive pregnancy test, BP
88/54 mmHg, HR 118. A. Threatened miscarriage B. Appendicitis C. Ruptured ectopic
pregnancy D. Ovarian torsion
6. 6-week-old infant, projectile non-bilious vomiting after feeds, palpable olive in RUQ. A.
GORD B. Infantile hypertrophic pyloric stenosis C. Volvulus D. Sepsis
7. 58-year-old man, sudden right arm & leg weakness + expressive dysphasia, onset 90
minutes ago, CT no bleed. A. Aspirin 300 mg stat B. IV alteplase (if no contraindications)
C. Clopidogrel 300 mg stat D. LMWH therapeutic dose
, 8. 71-year-old woman RA on methotrexate, 4 months progressive dry cough + SOB, CXR
bilateral interstitial changes. A. Rheumatoid ILD B. Methotrexate pneumonitis C.
Pulmonary embolism D. PCP pneumonia
9. 19-year-old man, sudden severe left testicular pain 3 hours, nausea, high-riding tender
testis, absent cremasteric reflex. A. Urgent scrotal ultrasound B. Immediate surgical
exploration C. IV antibiotics + analgesia D. Conservative management 6 hours
10. 65-year-old smoker, 5 weeks cough + haemoptysis + 7 kg weight loss, CXR right hilar
mass. A. Sputum cytology ×3 B. Staging CT chest/abdomen/pelvis C. Bronchoscopy first
D. PET-CT immediately
11. 34-year-old woman, severe headache, neck stiffness, photophobia, fever 39.2°C, drowsy
but obeys commands. A. CT head then LP B. IV ceftriaxone 2 g + IV aciclovir
immediately C. Dexamethasone 10 mg IV first D. Oral amoxicillin
12. 69-year-old COPD patient, 4 days productive cough, increasing SOB. ABG on 28% O₂: pH
7.27, PaCO₂ 10.1 kPa, PaO₂ 6.2 kPa. A. Nebulisers only B. Prednisolone + antibiotics C.
Non-invasive ventilation (BiPAP) D. Immediate intubation
13. 54-year-old man AF on warfarin, large melaena, BP 89/52 mmHg, INR 8.4. A. Vitamin K
10 mg IV B. Fresh frozen plasma C. Prothrombin complex concentrate (4-factor PCC) D.
Tranexamic acid only
14. 78-year-old woman, 3 weeks progressive confusion, urinary incontinence, wide-based
gait. CT → ventriculomegaly, no atrophy. A. Alzheimer’s disease B. Vascular dementia C.
Normal pressure hydrocephalus D. Lewy body dementia
15. 41-year-old woman, menorrhagia 9 months, Hb 79 g/L, ferritin 5 μg/L, normal pelvic
ultrasound. A. Tranexamic acid during periods B. Levonorgestrel IUS (Mirena) C.
Tranexamic acid + mefenamic acid D. Endometrial ablation first
